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General NPI Number Information
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NPI Number | 1245258722
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Entity Type | Organization
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Legal Business Name | COVERED BRIDGE FAMILY RESOURCES LLC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 77 WEST 5TH STREET
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City | ZUMBROTA
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State | MN
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Zip | 55992
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Country | US
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Telephone | 507-732-4136
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Fax | 888-527-4602
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | ZUMBROTA
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State | MN
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Zip | 55992
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Country | US
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Telephone | 507-732-4136
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Fax | 888-527-4602
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANDREA KRISTIN SMOTHERS
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Credential | MSW LICSW
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Telephone | 507-732-4136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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